Provider Demographics
NPI:1568441376
Name:RATNANI, M. SALIM (MD)
Entity Type:Individual
Prefix:MR
First Name:M. SALIM
Middle Name:
Last Name:RATNANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 MACCORKLE AVE SE
Mailing Address - Street 2:SUITE 811
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1223
Mailing Address - Country:US
Mailing Address - Phone:304-720-1875
Mailing Address - Fax:304-720-1878
Practice Address - Street 1:3100 MACCORKLE AVE SE
Practice Address - Street 2:SUITE 811
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1223
Practice Address - Country:US
Practice Address - Phone:304-720-1875
Practice Address - Fax:304-720-1878
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18570208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0129149000Medicaid
WV0129149000Medicaid
WVRA0754962Medicare ID - Type Unspecified